Intentional Side Mesh Recanalization of a Wallstent to Restore Patency of the Hemodialysis Access-Related Efferent Vein Occlusion

Impairment of hemodialysis shunt function due to chronic stenosis or occlusion of the draining vein can be treated by percutaneous balloon angioplasty or insertion of a stent (Vorwerk et al., Radiology 1995; 195: 140). Primary patency rate of the stented shunt is rather low mostly due to neointimal restenosis and revision can be performed by additional angioplasty or eventually by restenting. We describe an uncommon case of shunt dysfunction due to the combination of chronic proximal occlusion of the efferent vein and anatomical misplacement of a previously inserted stent. Treatment consisted of angioplasty and stent placement after wire-mesh stretching of the misplaced Wallstent. This technique is already described in biliary interventions as well as in a TIPS-procedure. To our knowledge this is the first report of use of this technique in a hemodialysis shunt.